Open Enrollment

May 1 through May 31, 2020

If you do not plan to make changes, all current elections will remain in place

except for the FSA, which you must enroll or reenroll in each year.

Benefits effective July 1, 2020 – June 30, 2021

Enhancements & New Offerings

Enhanced Vision Eligibility

Pet Insurance

Also Included

Medical Benefits

Dental Benefits

Vision Benefits

Life, AD&D, and LTD Insurance

Additional Benefits

You must enroll/re-enroll in the

FSA

Important Contacts

Your Choices.

Your Benefits.

CoverageChoice Plus Core Plan Tiered Core Plan Choice Plus HDHP/HSA Plan

In-Network In-Network In-Network

Annual Deductible Individual Family

$500$1,000

$750$1,500

$2,500 (for plans covering EE only)

$6,000 ($3,000 / member)

Out-of-Pocket Maximum Individual Family

$4,500$9,000

$4,500$9,000

$3,000 (for plans covering EE only)

$8,000 ($4,000/member)

Physician’s Office Visits Primary Care Specialists X-rays, lab work, etc.

$20 copay$30 copay

20% after deductible

$25 copay$40 copay

30% after deductible

10% after deductible10% after deductible10% after deductible

Well-Child Care Office visits Immunizations

Covered 100%Covered 100%

Covered 100%Covered 100%

Covered 100%Covered 100%

Adult Preventive Care Routine Physicals GYN exams Prostate exams Mammograms

Covered 100%Covered 100%Covered 100%Covered 100%

Covered 100%Covered 100%Covered 100%Covered 100%

Covered 100%Covered 100%Covered 100%Covered 100%

Hospital Care Preadmission testing Inpatient treatment

20% after deductible20% after deductible

30% after deductible30% after deductible

10% after deductible10% after deductible

Outpatient Facility and Physician Services Outpatient surgery Ambulance service Emergency room

20% after deductible20% after deductible$250 copay + 20%**

30% after deductible30% after deductible30% after deductible

10% after deductible10% after deductible10% after deductible

Behavioral Health Inpatient Outpatient

20% after deductible$20 copay

30% after deductible$25 copay

10% after deductible10% after deductible

Retail Drug 1

(31 day supply) Generic Preferred brand Nonpreferred brand

$10 copay$30 copay$80 copay

$10 copay$40 copay

$100 copay

*UHC Preventive Rx$10 after deductible$30 after deductible$80 after deductible

Mail-Order Drugs (90 day supply) Generic Preferred brand Nonpreferred brand

$20 copay$60 copay

$160 copay

$20 copay$80 copay

$200 copay

*UHC Preventive Rx$20 after deductible$60 after deductible

$160 after deductible

Medical BenefitsQuality health coverage is just one of the valuable benefits you enjoy as a Columbus State

Employee. Columbus State’s medical plan offers great flexibility in managing care for you and

your family. As part of your benefit package, you have the option of choosing between three

different medical plans through United Healthcare to best fit your needs.

Eligibility InformationColumbus State recognizes the importance of providing our employees and their families with quality benefits as part of the overall compensation package. The benefits package delivers quality and value while satisfying the diverse needs of our workforce. This summary highlights the benefit options offered for the 2020-2021 plan year. To find more details about the benefits in this brochure please visit:cscc.edu/employee/hr/benefits

Making Changes During the YearGenerally, you can only change your benefit elections during the annual benefits Open Enrollment Period. A Qualifying Life Event (QLE) such as marriage, divorce, birth, adoption, dependent age, and the open enrollment of your spouse’s employer may provide the ability to make a change. You must notify Human Resources with 31 days of any QLE to make changes. Otherwise, you’ll have to wait until the next open enrollment period. Any changes you make to your benefit plans must be directly related to the life event. Proof of the change is required (example: a marriage license or birth certificate).

When Coverage EndsMost benefits end at termination or the last day of the month following last day worked, QLE, or dependent age limit reached. However, under certain circumstances, you may continue your health care benefits through COBRA.

The health and happiness

of you and your family is a high priority. That’s why we offer a benefits package to help you and your loved ones feel secure.

For a complete list of covered services and exclusions, please refer to your “Summary Plan Description”.

*UHC Preventive RX list includes drugs available at a retail copay of $10/$30/$80 and Mail order of $20/$60/$160 where the deductible does not apply.** $250 copay for Teamsters

1Walgreens Pharmacy is out of network.

Think Healthy.

Live Well.

Dental BenefitsHealthy teeth and gums are an important part of maintaining your overall health. Columbus State’s dental plans are provided through

Delta Dental, which includes an extensive network of providers. Employees have the opportunity to choose between two dental

benefit plans to best fit your needs.

Delta Dental PPO Plan 1 Delta Dental Buy Up Plan 2

Vision BenefitsWith Columbus State’s vision plan, the focus is on you. Columbus State is pleased to offer vision coverage through VSP. Having

vision coverage allows you to save money on eligible eye care expenses. Eligibility up to age 26, unmarried and living in the US,

regardless of student status.

Coverage PPO In-Network

PremierIn-Network Out-of-Network

Annual Deductible (Individual/Family)

None $50 / $150 $50 / $150

Preventive and Diagnostic Treatment

0% 0% 0%

Basic Treatment 10% 20% 20%

Major Treatment 40% 50% 50%

Annual Maximum Benefit $1,500 $1,500 $1,500

Orthodontia Lifetime Maximum $1,000 $1,000 $1,000

PPO In-Network

PremierIn-Network Out-of-Network

None $75 / $225 $75 / $225

0% 0% 0%

10% 20% 20%

40% 50% 50%

$2,500 $2,500 $2,500

$1,500 $1,500 $1,500

Coverage In-Network Out-of-Network

Frequency Exam 12 MonthsLens 12 Months

Frames 24 Months

Annual Eye Exam $10 copay $35 allowance

Contact Lens Fit and Follow-up 15% off not to exceed $60 N/A

Frames Up to $130 allowance $45 allowance

Prescription Lenses Single vision Bifocal Trifocal Lenticular

$25 copay$25 copay$25 copay$25 copay

$25 allowance$40 allowance$55 allowance$80 allowance

Contact Lenses Medically necessary Elective

Covered at 100%Up to $135 allowance

$210 allowance$105 allowance

For a complete list of covered services and exclusions, please refer to your “Summary Plan Description”.

For a complete list of covered services and exclusions, please refer to your “Summary Plan Description”.

More Protection.

More Choice.

Life, AD&D, and LTD Insurance

Coverage

Life, AD&D, and disability insurance aren’t

something you think about everyday, but

they should be an important part of

everybody’s financial planning – no matter

what your age. Your benefit program

offers the following coverages to help

protect you and your family when it’s

needed most:

Basic Life and AD&D (company-

paid)

The basic life benefit amount is equal

to two times the employee’s base

annual salary to a maximum of

$340,000. AD&D insurance provides a

benefit to you or your beneficiary if,

due to an accident, you suffer loss of

life or limb.

Supplemental Life and AD&D

(employee-paid)

Employees may purchase one or two

times their base annual salary up to a

maximum of $340,000.

Long Term Disability (company-

paid)

Long- term disability (LTD) coverage

provides up to 60% of base salary per

classification

For a complete list of covered services and exclusions, please refer to your

“Summary Plan Description”.

Additional Supplemental Benefits

Core Benefits

Columbus State offers you additional voluntary benefits to help provide financial protection. Supplemental medical insurance can help protect you from significant expenses not covered by your medical plan. In fact, based on your situation, you may be able to save money by adding a supplemental plan to a lower cost medical plan. Be sure to consider your anticipated medical needs for the year along with the cost of the medical plans available to you.

AccidentProvides cash benefits in cases of eligible accidental injuries to help pay for uncovered medical expenses like your deductible or coinsurance, or for ongoing living expenses.

Critical IllnessProtects against the financial impact of certain illnesses, such as a heart attack or cancer. You receive a lump-sum benefit to pay for your treatment costs or for everyday living expenses like special transportation services or daycare.

Hospital IndemnityProvides cash payments for eligible hospital stays that you can use to cover expenses your medical plan does not cover such as deductibles, coinsurance, and other out-of-pocket costs.

Pet InsuranceYou work hard to provide your family with everything they need. So whether your family includes kids with two feet or kids with four paws, you know what responsibility looks like.

Pets are unpredictable. While it’s hard to anticipate accidents and illnesses, pet insurance makes it a little easier to be prepared for them. From preventive care visits to significant medical incidents, pet insurance provides protection for pets when you need it most.

Cancer Bridge This employer provided benefit offers personalized access to oncology specialists. Cancer Bridge is a cancer navigation resource for you and your family. CSCC wants to make sure you get all of your questions and concerns addressed by world class experts.

How it works:

Simple Enrollment.

Decision Support.

How to EnrollColumbus State’s Benefit Platform allows easy enrollment with built in decision support. This

simplified shopping experience will help you make informed decisions with confidence when

electing coverage.

Step 1 – Before Enrolling

• Gather all your dependent information. Legal name, social security number,

and date of birth.

• Children – the birth certificate or adoption papers

• Spouse – marriage certificate plus your most recent 1040, the top

half that shows marital status

• Domestic partner – notarized domestic affidavit

Step 2 – Enroll Online• Log on information:

• https://csccbenefits.hrintouch.com

• Create your user name and password. (This will be used for the website and

the APP. Once the website is complete, you may download the APP for

access on any smart device.)

• BenefitFocus

• Company ID: csccbenefits

Step 3 – Finalize Enrollment• Once your enrollment is completed, click on the Benefit Detail Report to

verify that you completed all sections of the enrollment process. This report

will show you all the benefits elected, the level of benefit, and each

dependent enrolled by benefit level.

Who to call for help:

First time Logging in?

Follow these steps

Previously created a user

name and password?

To log on, use the same

user name and password

that you use to access the

benefit portal for

enrollment and updates.

Reach out to CSCC’s Benefits department should you have any questions regarding

your benefit elections or how to enroll. Direct your emails to benefits@cscc.edu.

Additional BenefitsCreate a healthy balance with benefits that help

you feel and live better today – and actively plan

for tomorrow.

Health Rewards – Rally – Well-being

Participation in well-being may save on your

contributions.

Flexible Spending Accounts (FSAs)

Set aside pretax dollars out of your pay for

qualified health care and dependent care

expenses subject to IRS limits.

Transportation Reimbursement

Set aside pretax dollars out of your pay for

qualified parking and transportation expenses

subject to IRS limits.

Employee Assistance Program (EAP)

Receive confidential help for everyday situations

and personal difficulties such as depression,

dependency, job-related stress, even legal and

financial concerns.

-Regular part time employees up to 3 visits.

-Full time employees up to 8 visits.

Paid Time Off (PTO)

Your benefits program provides paid time off

including holidays to help you relax and refresh

away from work. Please refer to Policy 3-05 for

Vacation Leave and Policy 3-10 for Sick Leave.

Family Medical Leave

May provide job-protected unpaid leave for

qualified medical and family reasons. Please refer

to Policy 3-36.

Tuition Reimbursement & Fee Waivers

Please refer to Policy 3-08 for Fringe Benefits.

More Benefits.

Key Contacts.

Important Contacts

Please contact the individual company/provider listed here to learn more about a specific benefit plan. We also invite you to

speak with your HR representative.

Benefit: Contact: Phone: Website:

Enrollment/Eligibility Questions Jason Love 614-287-2107 jlove8@cscc.edu

Cancer Bridge Cancer Bridge 855-366-7700 N/A

Dental Delta Dental 800-282-0749 www.deltadentaloh.com

EAP MATRIX 614-475-9500 www.matrixpsych.com

Family Medical Leave Treschelle Kendrick 614-287-5755 tkendric@cscc.edu

FSA TASC 800-422-4661 www.tasconline.com

HSA Optum Bank 800-243-5543 www.optumbank.com

Life/AD&D MetLife 800-523-2894 www.metlife.com/individual

Long-Term Disability MetLife 800-858-6506 www.metlife.com/individual

Medical United Healthcare 888-252-6420 www.myuhc.com

Vision VSP 800-877-7195 www.vsp.com

Pet Insurance Nationwide 855-525-1458 www.petbenefitsportal.com

CI, HI, ACC MetLife 800-438-6388 www.metlife.com/insurance

Identity Theft InfoArmor 800-789-2720 www.myprivacyarmor.com

About this Guide

This guide describes the benefit plans and policies available to you. The details of

these plans and policies are contained in the official plan and policy documents.

This guide is meant only to cover the major points of each plan or policy. It does

not contain all of the details that are included in your Summary Plan Descriptions

(as required) found in your other employee benefit materials. If there’s ever a

question about one of these plans and policies, or if there’s a conflict between the

information in this guide and the formal language of the plan or policy documents,

the formal wording in the plan or policy documents will govern.

Note: The benefits described in this guide may be changed at any time and don’t

represent a contractual obligation – either implied or expressed – on the part of

your employer.